Moms for years have telling us to sit up straight and have good posture. They were probably right! First sitting at school, then grinding away to our computers at work and now spending our social lives slouched over our mobile devices, all are conducive to long term orthopedic consequences.

We go from standing tall early and end up with the thoracic spine alignment and function of Charles Montgomery Burns. It all started once we sat down at our desks in kindergarten!

It’s more than than just posture. 21st Century living, disuse, overuse, stress, lack of mobility and local articular issues often lead to dysfunction and impairment of the thoracic spine.

The difference between impairment and dysfunction is semantics. The dictionary reads that impairment can mean beingdiminished,weakened,or damaged and dysfunction means malfunctioning. I like to think of dysfunction as starting locally and impairments as being part of a regional or systematic issue.

For example a restricted rib in the thoracic spine after sleeping in a funky position vs. restricted thoracic rotation done a mal-alignment in the lumbo-pelvic-hip complex. Either way something is not working right and it is either located or manifesting in the thoracic spine. Here is a short video discussing different types of musculature that influence structure and function of the thoracic spine.

A poorly functioning T-spine can lead to; inefficient load transference, dysfunctional breathing, pain, headaches, decreased athletic performance and shoulder, elbow or neck injuries. I have had students, adults and athletes alike report any combination of these symptoms with the route cause being thoracic dysfunction.

Thoracic spine dysfunction can be observed during basic movement patterns. Quick screens like having clients raised their arms overhead, perform spinal rotation in each direction and even holding a plank can help you assess thoracic mobility. If the arms can’t be raised overhead without compensation at other joints, or if there is an asymmetry in rotation or if the client has trouble elongating the spine then you might want to further investigate the T-Spine. Here is an older video of a mobility exercise that can be used simultaneously assess and improve thoracic mobility.

Another popular corrective approach is Grey Cook‘s Functional Movement Systems (FMS). The FMS training cycle flows from Mobility to Static Motor Control, Dynamic Motor Control and then to Strength. The FMS addresses joint mobility via motor control as well as places a spotlight on breathing which makes sense to me since breathing is such an important aspect of thoracic mobility.

I think there are many parallels and similarities between NASM’s approach and that which Grey promotes through the FMS. I enjoy drawing from both approaches.

Below are some videos that demonstrate some corrective techniques that can be used to enhance the health and function of the T-Spine.

Inhibit/SMR/Mobility

The levator scapulae and pectorals minor are often culprits restricting thoracic mobility. Here are some basic soft tissue release, inhibition or self myofascial release techniques to address the levator and pec minor.

Mobility

Mobility drills are helpful to open up these localized areas of dysfunction and to begin to restore local motor control. Here’s a version of one I like to use:

Motor Control/Activation

Integration/Strength

Integration, total body functional movement patterns and strength exercises should top off the corrective program.

Regardless of your school of thought or the specific techniques you use. I think we can all agree that identifying and addressing thoracic dysfunction will go a long way in enhancing the effectiveness of our programming for our clients, patients and athletes.

Not loss of respect, but loss “and” respect. At what age do kids understand the permanency of death? Most five years olds don’t, at least not right away. Eight year olds? Nine year olds? It might sink in a little quicker for them. Showing respect around a wake, funeral or other ceremony to honor a recently deceased loved one must be tough for kids to get too. There is always the threat from the parents, “behave or else” at the funeral home, but whay should they? What good does being quiet or sad do for anyone? Especailly if they are getting to see cousins and other family members that they don’t get to see often. They just want to play. Bounce on the sofa, fill their pockets with mints from the funeral home candy dishes and get silly.

I experiecned this this today as my grandmother-in-law just passed away and we attended the wake last night and funeral today. The kids knew and loved her. They will miss her, but the respect piece, the solem atmosphere alluded them for the most part. Conversation after conversation with them proved fruitless. Calm talks, angry talks it didn’t matter. Until the funeral procession left the funeral home on the way to the church and an interesting occurrence transpired.

The procession passed by a softball field that was hosting a senior softball game? As the hearse crept past the field I witnessed a remarkable event. The game stopped and each player in the field, on the benches and fans in the stands all stopped what they were doing, stood up and placed their ball caps over their heart. They did not know who was in the hearse. They did not know our families in the cars that followed. But they knew loss. They knew respect. They grasped the preciousness of life. The value of each moment. Play for the day, honor those who are gone, hug those that grieve but smile because you can.

My kids saw this and were in awe. They got it. A lesson from total strangers. From a greater generation. It sunk in.

Fast forward three hours and my ten year old son asks if he can give a toast at the restauant where we were having the reception. I asked him what he wanted to say then explained that toasts were uncommon at these types of events. I thought about it for a minute or two and said that if he wanted to give a toast, I would support him and help him. He mulled it over for a few minutes then started clinking a salad plate with his metal fork. The din of 100 lunch guests drowned him out. We went to the front of the room, had him stand on a chair and asked his uncle, who read the eulogy at mass, to get everyone’s attention.

My son proceeded to speak clearly, from the heart, with volume and depth, with feeling and love in a succinct and articulate manner. He shared words that brought tears of pride, joy, love and rememberance to the eyes of many. His best line might have been his last “Nana will not only live on in our minds but also in our hearts”. He told me he added that line to make it a speech instead of a toast because his toast was not long enough to be a speech and toasts were uncommon at these types of things

The dangers of sitting have been highlighted over the past few years much to the delight of fitness professionals, movement therapists and the like.

“Over a lifetime, the unhealthful effects of sitting add up. Alpa Patel, an epidemiologist at the American Cancer Society, tracked the health of 123,000 Americans between 1992 and 2006. The men in the study who spent six hours or more per day of their leisure time sitting had an overall death rate that was about 20 percent higher than the men who sat for three hours or less. The death rate for women who sat for more than six hours a day was about 40 percent higher. Patel estimates that on average, people who sit too much shave a few years off of their lives.”-courtesy of this NY Times article:

http://www.nytimes.com/2011/04/17/magazine/mag-17sitting-t.html?_r=0

Another quick resource to peruse claims that sitting is the new smoking:

To keep things a bit lighter I want to remind you about the changes that occur in our myofascial system when we sit, or maintain any posture for more than 20 minutes. Creep starts to set in. We literally stiffen up (or soften up!). No shock right? Ever try and get up after a movie, long dinner or plane flight and feel tight? It’s not in your head, your tissues have changed.

Creep is the capacity of fascia and other tissue to lengthen when subjected to a constant tension load resulting in less resistance to a second load application. Aprogressivedeformation occurs overtime;itallows softtissuestotolerateappliedloadsbylengthening.

The guys at the M.E.C.A. Institute site a pertinent piece of literature in this discussion.

“Static flexion of the lumbar spine with constant load applied to the viscoelastic structures for 20 minutes and for 50 minutes resulted in development of spasms and inhibition in the multifidus muscles (e.g., deep erector spinae) and in creep of the supraspinous ligament in the feline model. The development of spasms and inhibition was not dependent on load magnitude. It is suggested that occupational and sports activities which require prolonged static lumbar flexion within the physiological range can cause a “sprain”-like injury to the ligaments, which in turn reflexively induce spasms and inhibition in some erector spinae muscles. Such disorder may take a long time to recover, in the order of days to weeks, depending on the level of creep developed in the tissues.”

The more time we spend in a seated position, the more prone we are to injury. Muscle imbalances develop, however the real threat may be the adaptations that are occurring on deeper levels.

So what do we do? Get up and move every 20 minutes or so. Take a walk. Do some stretches or Tai Chi. Hold downward facing dog or some other yoga poses.

Amble up to a co-workers desk and drop a deep hip flexor stretch off the edge of it. Hide in the stair well and bust out some mobility work. Hide a roller under your desk and use it when no one is looking…you make the call. Point is regular movement makes it easier to prepare for sport, life or training when we keep our tissues hydrated and lubricated throughout the day as bets as possible. It will cut down on our warm up time and reduce the likelihood of tissue strains.

I was one of the speakers at the Building a Better Athlete Summit: A Strength and Conditioning Summit for Middle & High School Coaches and Personal Trainers at the Park School in Brookline this past weekend. Mike Reinold, Jen Brickey and Susan Altman joined me as presenters. Mike’s session was Preventing Injuries and Enhancing Performance in Overhead Athletes, Jen spoke on Training the Female Athlete and Susan’s topic was Fueling the Athlete.

My session was titled Systematic Core Training for the Junior Athlete. Low back pain might not be as prevalent in the youth population, but dysfunction in the core region of the body most certainly is. From growth spurts, to poor and prolonged sitting posture in school, to nutritional triggers to over and under training there are many factors that can prevent the center of a young person’s body from working optimally.

Some challenges exist when programming for the junior client, especially if they are working in groups instead of 1:1. Complicated techniques are often ineffective. Try and keep things simple and fun, probably good advice for working with the adult population too. I also find that the younger athletes are more run down at the end of the school day compared to adults at the end of the work day. Maybe it is a nutritional deficit or just the fact that they are kids and need some down time.

I find better results easing into the program with some Self Myofascial Release (SMR), flexibility
or diaphragmatic breathing. However there are the times when working with groups of 8-12 year olds that I need to get them moving ASAP for everyone’s sanity. Scientific program design gets bent a bit when 15 hyper tennis players wound up from a long day at school and a hard session on court get dumped into your lap for some fitness training. I can see why my old coaches or P.E. teachers made us take the seemingly arbitrary “lap”. I know they weren’t texting, tweeting or posting pics on Instagram. They were probably just taking a deep breathe and trying to settle us down a bit.

Ideally I follow this flow:

1-SMR

2-Static Stretching/Mobility

3-Core Stability

4-Dynamic Flexibility and then either SAQ, Conditioning or Resistance Training, sometimes all three depending on the situation.

The basics work. Teaching pelvic tilts, finding neutral, creating congruity between the pelvis and the ribcage and then practicing disassociating the; spine from the pelvis, the pelvis from the hip, the spine from the humerus and the humerus from the scapulae from different positions with progressive acute variables is the plan.

Proprioceptive modalities (balance toys) can be used judiciously. Form and technique dictate all. If there is a slight wiggle, shaking, learning or subtle instability let the athlete continue to learn. If they are flailing or can not can control of their pelvis, ribs etc. regress the exercise.

Once there has been some neuromuscular “uptake” and activation, you can improve endurance, strength and conditioning of the core. Then you can get them moving, lifting and training with greater efficiency and lower risk of injury.

I am posting tonight to share my experiences with a pair of their shoes the Train//RX.

I have worn a handful of minimalist shoes over the last few years and have personal experience comparing and contrasting several brands and models. With anything I have found pros and cons with each of them.

The Train//RX at first glance looks like many of the shoes on the market that have a toes or toes separated from each other. However, the Train//RX is quite unique. The big toes are separated from the other four toes in the shoe. Not for bad behavior or anything like that, but to promote natural foot mechanics similar to the Japanese Tabi shoe. This approach is supposed to provide greater agility and connectivity to the ground. It does requires special socks, courtesy of Injingi.

When looking for a shoe the three basics that I look for are; zero drop, a wide toe box and minimal arch support. The “drop” of a shoe refers to the difference in height between the heel and the forefoot. Most shoes have an elevated heel, even the ones that you don’t expect like Nike Free for example. These kicks have zero drop. The toe box is the front of the shoe. It is where the toes live and many shoes are restrictive and do not let the forefoot and toes move properly during gait. Topo’s “Anatomic Toe Box” does just the trick. In regards to arch support, I prefer a non invasive shoe that let’s me pronate and supinate naturally though the foot. I found that to be the case with the Train//RX.

I eased into my “RXs” wearing them first while I worked with a couple of clients one day. Then I sported them for a couple of flexibility, core and upper body workouts over the next few days before moving to total body and leg training workouts. Within minutes of putting the shoe on for the first time I felt greater activation of my left VMO and left hip lateral rotators. I was not expecting this over such a short period of time. I have pretty good self awareness, but didn’t realize I needed that. It felt good!

Over the next couple of bouts wearing the shoes, weird, but the my big toes had some separation anxiety from the other toes. Now I regularly wear other minimalist shoes that separate each individual toe, but this was different. During the first two times I wore them the medial aspect of each big toe almost felt aggravated form rubbing against the material but by the third time I wore them, that sensation disappeared. It was almost as if the big toe was accepting the new position, mobility and support the individual slot was providing it.

This next part sounds hokey but from the minute I put them on I wanted to run, jump, climb, pounce, explode! I felt the urge to move and felt more athletic. I kept the horse in the barn for the first few days mainly because I had a few ice hockey games to play in and wanted to have fresh legs on the ice. I also like to take my time getting used to changes in footwear without progressing to sharply in duration of usage, frequency or application of load.

When I did train total body and legs I felt great. My lifts or vertical leap did not shoot up, but I felt great. During walking lunges my back foot stayed straighter. My feet gripped the ground. My hips got better activation. Landing multiplanar plyos felt easier too. I did truly feel more connected to the ground and I didn’t read that as a claim from Topo until after the workout.

I liked that there was something between me and the floor. There is a time and place for being barefoot like running on the grass or playing in the sand etc but in the gym with a thin-ish rubber mat over a concrete floor, I like to have some cushioning. I don’t want to be bouncing or floating, but something to make the unforgiving concrete…well…more forgiving.

Not only did I feel great, but the shoe felt great. You can tell it is well made. The seams, the breath-ability, the edges of the shoe that contacts the skin around the calve and side of the ankle were all comfortable. It is sturdy. The laces are thicker and seem like they will hold up through gym based workouts, outdoor runs and adventure races. I am not sure that I would want to be wearing the RXs for a full workday however. I am not sure there is enough breath-ability for that. The other Topo products may breathe better and truth be told this is a shoe of action. I am not sure it was designed to be worn training clients all day.

I am considering the Run//RT shoe for my daughter for cross country this season. I will have her try a pair on.

Here is the tale of the tape on the Train//RX:

// 3 MM REMOVABLE EVA FOOTBED

// PERFORATED AND AEGIS LINED FOR BREATHABILITY AND ODOR RESISTANCE

// 4 MM RUBBER OUTSOLE / 6 MM EVA MIDSOLE

// MEN’S WEIGHT: 7.8 OZ (SIZE 9)

// WOMEN’S WEIGHT: 6.3 OZ (SIZE 7)

If you are looking for an athletic shoe to train in that is built to let you move the way you’re built, then I suggest you try the Topo Train//RX. The separation of the big toe might be much for someone with an adducted big ray (big toe). Some corrective exercise work work in the foot, lower extremity and hip may be required prior being able to wear this shoe comfortably. This shoe is potentially a safer transition from an overbuilt shoe to some of the more minimalist shoes on the market today due to the depth of the sole and Tabi-style. I look forward to more adventures with the RX soon.